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Beyond the cervix....

Posted Feb 20 2009 7:22pm

From time to time I check in with myself on the philosophical guidelines that rule who I am as a midwife. Lately I seem to be up against a concept in midwifery that obstetrics has taught us is the cornerstone of their understanding of the laboring woman.

Midwives have intimate access to a woman's body that sometimes she herself or her partner doesn't have.

In short we have access to her cervix and its nuances. We have knowledge about how it "should" operate in labor and we have predetermined that it should open in a fairly regular pattern. Midwives worry about cervical scarring, we worry about cervical lips, we worry about effacement, we worry about swelling of the cervix, we worry about stripping the cervix of its most precious membranes, we worry about tearing of the cervix and numerous other things that have to do with the function of this very intimate organ.

And sometimes we just like to mess with it. I have had lately many opportunities to mess with women's cervices....grrrrrrrrrrrrrrrrrr

I don't enjoy it. Lately I have had a run of lovely births where the cervix has been a huge topic of consternation. I, universe, would like for that to be over please. Please ask me not to do an exam. No more cervical exams, lets trust the body please that it knows what to do, that it will take care of its own cervical lips. I don't want to push anymore back or watch someone do that at a birth.

Yes i know i know...be careful what you ask for. Fine I am willing to deal with the consequences and have dealt with it.

At MLL in 2007 (gosh it has been over a year since I left). I took pride in creating an environment in the birth space of the woman where babies choose to glide out without but the first cervical exam upon intake in labor.

I caught many babies on my knees with the woman standing, where the mom almost as a reflex pushed her baby out. NO cervical exams to check that she was fully dilated, no moving back cervical lips. Hands out of the vagina and hands off the cervix.

I love to watch a woman labor when she is left alone....

It generally goes like this: in active labor her contractions start, they stop, the start, they stop, they ebb and flow and get longer and more intense, a woman is upright, she follows the roll of the waves of the contractions, she whispers, she moans, she prays, she leans on someone or something when the contraction peaks.

The midwife is patient, she doesn''t bring her worry into the room. She checks all of the necessary vitals and babys heartbeat in a non invasive way. She asks permission, she uses a quiet voice, she doesn't bring other peoples fear into the room.

If a woman is not asked to lay down for a cervical exam, no one knows what her cervix is doing in these moments....only the cervix knows.

She continues in this pattern of changing positions, upright and walking is usually the position of choice unless someone tells her that there are better positions.

If she has not read a book or seen a poster about different positions for laboring, she will naturally choose the upright and walking position. Contractions space closer together, perhaps one on top of the other.

Then there is a pause, she stops walking in some point in her labor and begins to bend her knees at the peak of contractions. She is immersed in the process, she is internal, she is breathing and sweating and possible moaning.

She is not pushing, she is bending at the knees, not in a complete squat, but halfway there. Sometimes a woman may bend at the waist and hold her partner and then squat. No one has told her to do so.

I love it when this happens. The baby is probably coming soon, better put on gloves.

Put on gloves.

Next contraction here it comes... another deep bend at the knees and then sometimes......a huge splash, fluid possibly poop from the mom comes. It can be mighty messy.

This is usually followed by a very intense, very long grunting push.

Sometimes the baby crowns here, sometimes that one push is enough for the baby to be born.

I love births like this. I actually had one birth where the mom got up after trying to rest a bit, squatted a bit and the baby slid out onto the bed. I heard the cry. She was still in her nightgown, I guess she had her underwear off! I did not see the baby born just heard the cry behind her.

I wasn't being negligent, I didn't know the baby was coming. She pushed once, one deep down reflexive push. BORN!

Midwives talk about the fetal ejection reflex. It exists, I have seen it over and over and over and over again. I love it, it makes me smile....it gives me joy because the woman has done it, no one has told her body that it is ready. No one has checked her cervix, messed with a lip, worried about it swelling or tearing. A woman doesn't even know to push, it just happens and then the baby is born, ususally to a surprised bunch of people.

Go cervix, go mamma, go fetal ejection reflex. The body is an amazing thing and it deserves respect for its wisdom.

Once when I was a new doula a mom had a particularly intense back labor and was getting frustrated. She got up to go pee and then looked at me. She asked me pointedly hanging on the door handle to the bathroom. "When will I know when to PUPPPPPPPPPPPPPUUUUUUUUUUUUUSSSSSSSSSSSSSSHHHHHHHHHHH" in a very deep gruntly sort of way. My response "um I think you are"
"NO I am noooouuuuuuuoooooooooooottttttttt"
the baby was born shortly thereafter.

Is this turning into a rant? Perhaps, but I am just affirming to myself my original desire to be as hands off as possible.

Do you think all midwives start out with this desire and then experience makes them want to always check a woman's cervix?

Say for example if you missed a breech? Would that cause you to do more exams? Or say you had a once upon a time super long push because the cervix was still having a stubborn lip....that wouldn't budge. NOOOT that I have had any of those experiences uh hum....

I know that we are formed by our experiences, there is a saying in the birth world. " We are a product of our last 5 births" I would like that not to be true.

OK universe? Lets leave the lip alone and it will melt away. Lets be patient and ask the mom to wait for her next exam. Lets not touch what works so perfectly until we see signs that it might be getting tooo tired and not grunty enough, and after that wait some more. Lets protect the birthing environment, let our anxiety go before we open the front door. Lets keep the lights low and wait.
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